Congressional Black Caucus Community Health Centers Forum Lisa Cox, Assistant Director, Federal Affairs September 27, 2007 School-Health Financing: What Are the Options? School-Health Initiatives Midwestern Regional Conference Lisa Cox Assistant Director for Federal Affairs National Association of Community Health Centers Thursday, July 24, 2008 Indianapolis, IN National Association of Community Health Centers

Who We Are NACHC is the national trade association serving and representing the interests of America’s community health centers Our Mission To promote the provision of high quality, comprehensive health care that is accessible, coordinated, culturally and linguistically competent, and community directed for all underserved populations. National Association of Community Health Centers

Community Health Centers  Include:  Community Health Centers  Health Care for the Homeless Centers  Migrant Health Centers  Primary Care Programs in Public Housing Also known as Federally Qualified Health Centers or FQHCs COMMUNITY HEALTH CENTERS

America’s Voice for Community Health Care The Facts About the Federal Health Centers Program  Approximately 1,000 health centers – over 6,000 sites  Equally distributed between urban and rural locations  18 million people  Patient-Majority Boards of Directors  Location in Medically-Underserved Areas  Open to All  Comprehensive Services  Performance & Accountability Requirements

 Health Services related to: Family Medicine Internal Medicine Pediatrics Obstetrics  Diagnostic Laboratory and Radiologic Services  Mental/Behavioral Health  Dental Screenings  Pharmaceutical Services  Referrals to Other Providers  Patient Case Management and…  Enabling Services: Translations Transportation Outreach Health Education Services

Total Revenue Received by BPHC Grantees – ,002 Grantees * Health Centers meeting federal grant requirements and receiving Section 330 funding. ** Includes state, local, foundation, and private grants and contracts. Source: Bureau of Primary Health Care, 2004 Uniform Data System Note: Percents may not sum to 100% due to rounding.

Financing Federal Health Centers Program Federal support for SBHCs primarily flows from the Bureau of Primary Health Care. SBHCs must: –Be a public or private nonprofit entity under an FQHC. –Demonstrate compliance with the Health Centers statute and Bureau of Primary Health Care guidelines. –Submit a Memorandum of Agreement (MOA) establishing commitments from the host school’s principal and school superintendent/school board. –Serve a defined geographic area that is federally designated, in whole or part, as a Medically Underserved Area (MUA) or a Medically Underserved Population (MUP). –Eligible applicants may apply for SBHC funding through the Bureau of Primary Health Care’s “new access points” initiative.

Financing Federal Health Centers Program All organizations that previously have been awarded Section 330 funding specifically to support a SBHC must comply with the requirements of section 330(e) Community Health Center Program. Funds to support these SBHCs should be identified or included in budget presentations as a request for section 330(e) CHC Program, funding. Any new organizations applying for 330 funds specifically to support a SBHC may do so under one of the programs set forth under section 330 by demonstrating compliance with the requirements of that subsection. New organizations requesting support under section 330 (g), (h), or (i), they must meet the requirements of the applicable section. Nationally competitive, multi-round process.

Financing Some SBHC services may be provided off-site through established arrangements within the applicant organization. SBHC applicants must propose a school- based health center that serves other community members in addition to the students attending the school(s) where the Shies located. Community members may be served in other locations operated by the applicant organization.

Financing Medicaid  Medicaid is the largest third-party revenue source for school-based health centers  Congress in 1989 made health center services a guaranteed benefit under the Medicaid program.  In 2000, a bipartisan majority of Congress established the Medicaid Prospective Payment System (PPS) for health centers  A SBHC may participate in Medicaid as an individually enrolled provider, or through a sponsoring organization such as a community health center that is enrolled as a Medicaid provider.

Financing  The receipt of grant funds from Federal, State or local governments or foundations is not a factor in whether a SBHC can participate in Medicaid as an enrolled provider.  Grantees of such funds are able to provide services and bill Medicaid for services provided to Medicaid enrollees.  FQHCs that serve as a sponsoring organization for a SBHC can include the SBHC services under the FQHC Medicaid reimbursement provisions. Note that when the SBHC is an FQHC, Medicaid beneficiaries are entitled to SBHC services covered by Medicaid.

Financing New School-Based Health Legislation NACHC has been working with the National Assembly of School Based Health to support S. 600, legislation that creates a new federal school-based clinic program. NACHC fully supports this effort. The purpose of S. 900 is to formally authorization and fund school health clinics to: provide comprehensive primary public health services to underinsured and at-risk children, adolescents and their families at locations accessible to these individuals; and improve the physical health, emotional well-being, and academic performance of low- income, underinsured or otherwise at-risk children and adolescents.

Financing New School-Based Health Legislation Priorities for S. 600 go to: Communities and neighborhoods that demonstrate highest need among school age population: uninsurance, geographical access, health professional shortage, poor performing school, poor health outcomes, poor health and mental health utilization rates as measured. Eligibility for grants would give priority status to preferred providers that include community health and mental health care organizations with demonstrated track record for serving underserved child and adolescent populations and ability to collaborate across education, public health, mental health, and primary care systems.

Financing –Grants would be used to expand a community’s existing school health clinic network or establish a new program where none exists. –Grants would allow scope of service to be determined by community and reflect accepted standards of practice for pediatric care. –Health care providers, parents and school officials would all play a role in the tailoring of services to meet the needs of child and adolescent populations served.

2008 State Funding for Health Centers

Financing Financing Goals Federal Efforts Increased funding for federal Health Centers Program Increased support for S. 600 and movement of bill SCHIP reauthorization State Efforts Increased funding for health centers and other community-based providers